Bone positioning and cutting system and method

ABSTRACT

A method of performing a bunion surgery may involve positioning a first portion of a bone positioning device over a first cuneiform and positioning a second portion of the bone positioning device over a first metatarsal with the bone positioning device extending across a joint separating the two bones. The second portion of the bone positioning device can be adjusted relative to the first portion about a first axis and about a second axis. The method may involve moving the second portion of the bone positioning device relative to the first portion of the bone positioning device about the first axis and the second axis, thereby moving the first metatarsal relative to the first cuneiform in a first plane and a second plane. The method may also involve fixing a position of the first metatarsal relative to the first cuneiform with a bone connector.

RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 17/503,730, filed Oct. 18, 2021, which is acontinuation of U.S. patent application Ser. No. 17/201,008, filed Mar.15, 2021, issued as U.S. Pat. No. 11,147,590 on Oct. 19, 2021, which isa continuation application of U.S. patent application Ser. No.16/730,424, filed Dec. 30, 2019, issued as U.S. Pat. No. 10,945,764, onMar. 16, 2021, which is a continuation application of U.S. patentapplication Ser. No. 15/894,702, filed Feb. 12, 2018, issued as U.S.Pat. No. 10,555,757, on Feb. 11, 2020, which is a divisional applicationof U.S. patent application Ser. No. 14/799,981, filed Jul. 15, 2015,which claims priority to U.S. Provisional Application No. 62/024,546,filed Jul. 15, 2014. The entire contents of each of these applicationsare hereby incorporated by reference.

TECHNICAL FIELD

This disclosure generally relates to devices and methods for positioningand cutting bones.

BACKGROUND

In various surgical procedures, it can be necessary to cut one or morebones. Success of such surgical procedures may often times be a functionof the accuracy of the cut(s) being made to the one or more bones.Accomplishing accurate cuts can be especially complicated where surgicalprocedures involve cutting one or more bones that are relatively smallas compared to bones in other locations of a surgical patient's anatomy.Exemplary surgical procedures involving cuts to one or more relativelysmall bones can include surgical procedures involving a foot or hand. Tohelp facilitate accurate cuts to one or more bones, it may be useful toposition the one or more bones to be cut in a manner that is conduciveto a particular cut.

SUMMARY

One embodiment includes a bone positioning device. The embodiment of thebone positioning device can include at least one fixation pin forattachment to a first bone and at least one fixation pin for attachmentto a second bone. A first block having at least one aperture can beincluded for slidably receiving a fixation pin(s), and a second blockhaving at least one aperture can be included for slidably receiving afixation pin(s). A multi-axis joint can connect the first block and thesecond block, where the multi-axis joint allows the first and secondblocks to move with respect to each other about more than one axis.

Another embodiment includes a method for fixing an orientation of afirst bone with respect to a second bone. The embodiment of the methodcan include attaching at least one fixation pin to a first bone andattaching at least one fixation pin to a second bone. At least onefixation pin can be inserted within a respective aperture of a firstblock, and at least one fixation pin can be inserted within a respectiveaperture of a second block. The first block can be positioned along andabout the fixation pin(s) and a set screw(s) can be actuated to fix aposition of the first block along and about the fixation pin(s), andsimilarly the second block can be positioned along and about thefixation pin(s) and a set screw(s) can be actuated to fix a position ofthe second block along and about the fixation pin(s). The position ofthe first block can be adjusted with respect to the second block aboutat least a first axis and a second axis. A set screw can be actuated tofix a position about the first axis, and a set screw can be actuated tofix a position about the second axis.

A further embodiment includes a bone cutting guide. The embodiment ofthe bone cutting guide can include a plate defining a plane, a blockhaving a guiding surface integral with or coupled to the plate, with theguiding surface being parallel to the plane and being spaced laterallytherefrom. A handle can also be included extending from the plate.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings are illustrative of particular embodiments of thepresent invention and therefore do not limit the scope of the invention.The drawings are not necessarily to scale (unless so stated) and areintended for use in conjunction with the explanations in the followingdetailed description. Embodiments of the invention will hereinafter bedescribed in conjunction with the appended drawings, wherein likenumerals denote like elements.

FIG. 1 is a perspective view of a bone positioning device according toan embodiment of the invention;

FIG. 2 is a top plan view of the bone positioning device of FIG. 1 ;

FIG. 3 is a side plan view of the bone positioning device of FIG. 1 ;

FIG. 4 is a perspective cross-sectional view of the bone positioningdevice of FIG. 1 ;

FIG. 5 is a perspective view of a bone positioning device attached tobones in a skewed position according to an embodiment of the invention;

FIG. 6 is a top view of the bone positioning device of FIG. 5 ;

FIG. 7 is a side view of the bone positioning device of FIG. 5 ;

FIG. 8 is a side view of the bone positioning device of FIG. 5 ;

FIG. 9 is a perspective view of a bone cutting guide according to anembodiment of the invention;

FIG. 10 is a perspective view of a bone cutting guide according to anembodiment of the invention in contact with a saw blade; and

FIG. 11 is a side plan view of the bone cutting guide and saw blade ofFIG. 10 .

DETAILED DESCRIPTION

The following detailed description is exemplary in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description provides somepractical illustrations for implementing exemplary embodiments of thepresent invention. Examples of constructions, materials, dimensions, andmanufacturing processes are provided for selected elements, and allother elements employ that which is known to those of ordinary skill inthe field of the invention. Those skilled in the art will recognize thatmany of the noted examples have a variety of suitable alternatives.

Embodiments of the invention include a bone positioning device.Embodiments of the bone positioning device can be useful for temporarilyfixing bones in a desired position during a surgical procedure, such asa bone alignment, osteotomy, and/or fusion procedure. Such a proceduremay be performed, for example, on bones (e.g., adjacent bones separatedby a joint or different portions of a single bone) in the foot or hand.In one example, the procedure can be performed to correct an alignmentbetween a metatarsal (e.g. a first metatarsal) and a cuneiform (e.g., afirst cuneiform), such as a bunion correction. An example of such aprocedure is a Lapidus procedure. In another example, the procedure canbe performed by modifying an alignment of a metatarsal (e.g. a firstmetatarsal). An example of such a procedure is a Basilar metatarsalosteotomy procedure.

As shown in FIGS. 1-4 , the bone positioning device 10 can include atleast one fixation pin, such as a first fixation pin 20, for attachmentto a first bone 24. At least one fixation pin, such as a second fixationpin 30, can be provided for attachment to a second bone 34, such as anadjacent bone separated by a joint or different portions of a singlebone. As shown best in FIG. 4 , a first block 40 having a first aperture50 can slidably receive the first fixation pin 20, and a second block 60having a second aperture 70 can slidably receive the second fixation pin30. The first and second apertures 50, 70 can allow the first and secondblocks 40, 60 to slide along a longitudinal axis of the first and secondfixation pins 20, 30, respectively. The first and second apertures 50,70 can also allow the first and second blocks 40, 60 to rotate about thelongitudinal axis of the first and second fixation pins 20, 30,respectively. In some embodiments, each of the first and second fixationpins 20, 30 are generally cylindrical and have a distal portion and aproximal portion, with the distal portion threaded for retention withinthe respective first or second bone, while the proximal portion isunthreaded for both sliding within the respective first or secondaperture and free rotational movement within the respective first orsecond aperture. In some embodiments, the proximal portion has a uniformdiameter, such that it does not contain a flared or “head” portion. Insuch embodiments, the first and second blocks can be positioned on thefirst and second fixation pins before or after the pins are engaged withbone.

Again as shown best in FIG. 4 , a multi-axis joint 80 can be provided toconnect the first block 40 and the second block 60 and located adjacentto a joint 84 between the first and second bones. In some embodiments,the multi-axis joint 80 allows the first block 40 and the second block60 to move with respect to each other about more than one axis. Incertain embodiments, the multi-axis joint 80 allows the first block 40and the second block 60 to move with respect to each other about thethree cardinal planes (i.e., X, Y, and Z axes). In the embodiment shown,the multi-axis joint 80 allows for angulation in all directions androtation between the first and second blocks. FIGS. 5-8 depict anexemplary embodiment of the bone positioning device 10 attached to firstand second bones 24, 34, where the first and second bones are skewedrelative to each other. In this particular embodiment, a longitudinalaxis of second bone 34 is skewed about 15 degrees relative to alongitudinal axis of first bone 24.

The multi-axis joint can include any suitable structure for allowingdesired adjustments about more than one axis, such as desiredadjustments about three axes. In some embodiments, with reference toFIG. 4 , the multi-axis joint 80 includes a link 90 having a first end94 rotatably connected to the first block 40 and a second end 98rotatably connected to the second block 60. Such a multi-axis jointallows for the movement about the various axes discussed above at boththe first end and the second end. In the embodiment shown, the first end94 includes a first ball received within a first socket of the firstblock 40, and the second end 98 includes a second ball received within asecond socket of the second block 60.

Some embodiments of the device allow the relative positions of the firstand second bones to be fixed after a desired orientation has beenachieved. For example, a first set screw 100 can extend through thefirst block 40 into the first aperture 50 and be positioned against thefirst fixation pin 20, for fixation of the first block on a longitudinalaxis of the first fixation pin and/or about the longitudinal axis of thefirst fixation pin. Further, a second set screw 110 can extend throughthe second block 60 into the second aperture 70 and be positionedagainst the second fixation pin 30, for fixation of the second block ona longitudinal axis of the second fixation pin and/or about thelongitudinal axis of the second fixation pin. In certain embodiments,the first and second set screws are positioned perpendicular to thefirst and second fixation pins. As shown in FIGS. 1-3 , additional setscrews 120, 130 extending through the first and second blocks can bepositioned opposite of the first and second set screws, respectively.Such oppositely positioned set screws may facilitate use of the bonepositioning device on a left foot or a right foot depending on aparticular surgical procedure.

Set screws can also be provided to fix positions across the multi-axisjoint. In the embodiment shown in FIG. 4 , a first end set screw 140extends through the first block 40 and is positioned against the firstend 94 of the link 90. Further, a second end set screw 150 is shownextending through the second block 60 and positioned against the secondend 98 of the link 90.

The set screws can include any structure suitable to fix the relativepositions of the components described herein. In some embodiments, theset screws have a threaded connection with the blocks. Further, asshown, they can include a recess with a non-circular surface. Such arecess is useful for engagement with a driving tool, such as ahex-driver.

In some embodiments, the device can be used to apply a compression forcebetween two adjacent bones, or different portions of a single bone,while the bones are held in desired alignment and/or to facilitate adesired alignment between the bones. Such a compression force is usefulfor certain surgical procedures, such as bone fusions. As shown in FIG.4 , in some embodiments the device 10 includes a compression screw 160operable to exert a compression force between first and second bones 24,34 connected to first and second fixation pins 20, 30, respectively. Inthe embodiment shown, the compression screw 160 is generallyperpendicular to the fixation pins and is threadingly received within ablock and positioned to act against one of the fixation pins.

One of the blocks can be adapted to allow for relative movement to exertthe compression force. In the embodiment shown in FIG. 4 , one of theblocks (e.g., the first block 40) has a first portion 170 slidinglyconnected to second portion 180. An aperture (e.g., the first aperture50) extends through the first portion and the second portion. In thisembodiment, the first aperture has a first cross-sectional area in thefirst portion and a second cross-sectional area in the second portion,and the first cross-sectional area is smaller than the secondcross-sectional area. The set screw 100 can extend through the firstportion 170. The compression screw 160 can extend through the secondportion 180. Upon actuation, the compression screw 160 will act againstthe fixation pin 20 and will pull the second portion 180 of the block 40away from the fixation pin 20. The force will be transmitted through themulti-axis joint 80 through the other block 60 and fixation pin 30,thereby applying a compression force that tends to press togetherleading surfaces (e.g., interfacing surfaces) of the first and secondbones 24, 34.

Some embodiments include a bone cutting guide. Such a guide can beuseful for guiding the cutting of bone, such as after a position of thebone has been fixed by the device described above. Bone cutting may beuseful, for example, to facilitate contact between leading edges ofadjacent bones or different portions of a single bone, such as in a bonealignment and/or fusion procedure.

An embodiment of a bone cutting guide is shown in FIGS. 9-11 . In theembodiment shown, the guide 200 includes a plate 210 that defines aplane, a block 230, and a handle 240 extending from the block 230. Asshown, the handle extends from the block 230 at an angle of between 30and 60 degrees (e.g., 45 degrees) with respect to the plane. The plate210 can include a top edge, a bottom edge opposite of the top edge, andfirst and second opposite side surfaces. In the embodiment shown in FIG.9 , the block 230 can include a surface 250 parallel to the plate 210and offset from the plate by a distance (e.g., 1-20 millimeters). Asshown in FIGS. 10 and 11 , a cutting tool 260, such as a saw blade, maybe placed in apposition to the surface 250 to guide cutting in a planeparallel to the plate and offset from it by a distance (e.g., a distancethe surface 250 if offset from the plate 210).

In use, the bottom edge of the plate 210 can be placed such that itextends into a joint space or resected portion between the first bone 24and a second bone 34. The surface 250 can provide a cutting tool guidesurface operable to guide a cutting tool to cut a leading edge of a bonein a plane parallel to the plate 210.

Embodiments of the invention also include methods of temporarily fixingthe orientation of a first bone with respect to a second bone, such asduring a surgical procedure, using a bone positioning device. In someembodiments, the method includes a step of attaching a first fixationpin slidably and rotatingly received within a first aperture of a firstblock to a first bone and attaching a second fixation pin slidably androtatingly received within a second aperture of a second block to asecond bone. The method can also include the steps of positioning thefirst block along the first fixation pin and actuating a first set screwto fix a position of the first block along the first fixation pin.Likewise, the method can include the steps of positioning the secondblock along the second fixation pin and actuating a second set screw tofix a position of the second block along the second fixation pin. Insome embodiments, the method can include the steps of adjusting theposition of the first block with respect to the second block about atleast a first axis and a second axis and actuating a third set screw tofix a position about the first axis and actuating a fourth set screw tofix a position about the second axis. In certain embodiments, the methodcan also include actuating a compression screw to apply a compressionforce between the first and second bones. It should be noted these stepsneed not be performed in the order stated, which is merely exemplary.For example, the second fixation pin may be attached to the second bonebefore the first fixation pin is attached to the first bone, bothfixation pins may be attached before either block is adjusted or fixed,etc.

The method may also include steps following the fixing of the positionof the bones. Some embodiments of the method also include imaging (e.g.,with an X-ray) the first and second bones connected to the first andsecond blocks to confirm a desirable alignment. Certain embodiments ofthe method include fusing the first bone and the second bone, such as byattaching a bone connector (e.g., a plate, pin, screw, wire, or staple)to stably connect and fix the first bone and the second bone. Someembodiments also include the step of removing the first fixation pinfrom the first bone and the second fixation pin from the second bone,such as at a time after the bones have been stabilized and connectedwith a bone connector.

Some embodiments of the method also include cutting a leading edge ofthe first or second bone using a cutting guide, such as by positioning acutting guide proximate the bone (e.g., within a joint between adjacentbones or a resected portion of a single bone) and using the guide to cuta leading edge of the bone in a plane. Such embodiments can also includethe step of actuating a compression screw to apply a compression forcebetween the first and second bones after the cutting step.

Thus, embodiments of the invention are disclosed. Although the presentinvention has been described with reference to certain disclosedembodiments, the disclosed embodiments are presented for purposes ofillustration and not limitation and other embodiments of the inventionare possible. One skilled in the art will appreciate that variouschanges, adaptations, and modifications may be made without departingfrom the spirit of the invention.

The invention claimed is:
 1. A method of performing a bunion surgery,the method comprising: positioning a first portion of a bone positioningdevice over a first cuneiform and positioning a second portion of thebone positioning device over a first metatarsal with the bonepositioning device extending across a joint separating the firstmetatarsal from the first cuneiform, the second portion of the bonepositioning device being adjustable relative to the first portion of thebone positioning device about a first axis and about a second axis;moving the second portion of the bone positioning device relative to thefirst portion of the bone positioning device about the first axis andthereby moving the first metatarsal relative to the first cuneiform in afirst plane; moving the second portion of the bone positioning devicerelative to the first portion of the bone positioning device about thesecond axis and thereby moving the first metatarsal relative to thefirst cuneiform in a second plane; and after moving the first metatarsalrelative to the first cuneiform in the first plane and the second plane,fixing a position of the first metatarsal relative to the firstcuneiform with a bone connector.
 2. The method of claim 1, wherein: thebone positioning device comprises a first rotating connection, andmoving the second portion of the bone positioning device relative to thefirst portion of the bone positioning device about the first axis andthereby moving the first metatarsal relative to the first cuneiform inthe first plane comprises rotating the second portion of the bonepositioning device relative to the first portion of the bone positioningdevice about the first rotating connection and thereby moving the firstmetatarsal relative to the first cuneiform in the first plane, and thebone positioning device comprises a second rotating connection, andmoving the second portion of the bone positioning device relative to thefirst portion of the bone positioning device about the second axis andthereby moving the first metatarsal relative to the first cuneiform inthe second plane comprises rotating the second portion of the bonepositioning device relative to the first portion of the bone positioningdevice about the second rotating connection and thereby moving the firstmetatarsal relative to the first cuneiform in the second plane.
 3. Themethod of claim 2, wherein: the bone positioning device comprises a linkconnecting the first portion to the second portion; the first rotatingconnection connects the second portion of the bone positioning device tothe link; the second rotating connection connects the first portion ofthe bone positioning device to the link; moving the second portion ofthe bone positioning device relative to the first portion of the bonepositioning device about the first axis comprises moving the secondportion of the bone positioning device relative to the link about thefirst rotating connection and thereby moving the first metatarsalrelative to the first cuneiform in the first plane; and moving thesecond portion of the bone positioning device relative to the firstportion of the bone positioning device about the second axis comprisesmoving the second portion of the bone positioning device relative to thelink about the second rotating connection and thereby moving the firstmetatarsal relative to the first cuneiform in the second plane.
 4. Themethod of claim 3, wherein the second portion of the bone positioningdevice is configured to slide relative to the link, and furthercomprising, prior to fixing the position of the first metatarsalrelative to the first cuneiform with the bone connector, sliding thesecond portion of the bone positioning device relative to the firstportion of the bone positioning device to apply a compression forcebetween the first metatarsal and the first cuneiform.
 5. The method ofclaim 4, wherein the bone positioning device comprises a screw, andsliding the second portion of the bone positioning device relative tothe first portion of the bone positioning device to apply thecompression force comprises actuating the screw.
 6. The method of claim2, wherein: the first rotating connection comprises a first ballreceived in a first socket; and the second rotating connection comprisesa second ball received in a second socket.
 7. The method of claim 1,wherein: the first plane is a plane defined by X- and Y-axes, and thesecond plane is a plane comprising a Z-axis.
 8. The method of claim 1,wherein the first portion of the bone positioning device comprises afirst aperture and the second portion of the bone positioning devicecomprises a second aperture, and further comprising: inserting a firstfixation pin into the first aperture of the first portion and into thefirst cuneiform; and inserting a second fixation pin into the secondaperture of the second portion and into the first metatarsal.
 9. Themethod of claim 1, wherein moving the first metatarsal relative to thefirst cuneiform in the first plane and the second plane comprisescorrecting an alignment between the first metatarsal and the firstcuneiform to correct a bunion.
 10. The method of claim 9, wherein fixingthe position of the first metatarsal relative to the first cuneiformwith the bone connector comprises fusing the first metatarsal to thefirst cuneiform across the joint.
 11. The method of claim 1, whereinmoving the second portion of the bone positioning device relative to thefirst portion of the bone positioning device about the first axis andthereby moving the first metatarsal relative to the first cuneiform inthe first plane comprises actuating a threaded screw to set a positionof the second portion of the bone positioning device relative to thefirst portion of the bone positioning device about the first axis. 12.The method of claim 11, wherein an end of the threaded screw defines arecess configured to receive a driving tool, and actuating the threadedscrew comprises inserting the driving tool into the recess and actuatingthe threaded screw with the driving tool.
 13. The method of claim 1,further comprising, prior to fixing the position of the first metatarsalrelative to the first cuneiform with the bone connector, removing aleading edge of the first metatarsal and removing a leading edge of thefirst cuneiform.
 14. The method of claim 13, wherein removing theleading edge of the first metatarsal and removing the leading edge ofthe first cuneiform comprises cutting the leading edge of the firstmetatarsal with a cutting tool and cutting the leading edge of the firstcuneiform with the cutting tool.
 15. The method of claim 14, furthercomprising aligning a bone cutting guide with the joint, wherein cuttingthe leading edge of the first metatarsal with the cutting tool comprisesguiding the cutting tool with the bone cutting guide to cut the leadingedge of the first metatarsal and cutting the leading edge of the firstcuneiform with the cutting tool comprises guiding the cutting tool withthe bone cutting guide to cut the leading edge of the first cuneiform.16. The method of claim 14, wherein cutting the leading edge of thefirst metatarsal with the cutting tool and cutting the leading edge ofthe first cuneiform with the cutting tool comprises cutting the leadingedge of the first metatarsal with the cutting tool and cutting theleading edge of the first cuneiform with the cutting tool after movingthe second portion of the bone positioning device relative to the firstportion of the bone positioning device about the first axis and thesecond axis.
 17. The method of claim 1, wherein the bone connector isconfigured to promote fusion between the first metatarsal and the firstcuneiform.
 18. The method of claim 1, wherein the bone connectorcomprises one or more of a plate, a screw, a pin, and a staple.
 19. Amethod of performing a bunion surgery, the method comprising:positioning a first portion of a bone positioning device over a firstcuneiform and positioning a second portion of the bone positioningdevice over a first metatarsal with the bone positioning deviceextending across a joint separating the first metatarsal from the firstcuneiform, wherein the second portion of the bone positioning device isadjustable relative to the first portion of the bone positioning deviceabout a first rotating connection and about a second rotatingconnection, and the second portion of the bone positioning device isslidable relative to the first portion of the bone positioning device;moving the second portion of the bone positioning device relative to thefirst portion of the bone positioning device about the first rotatingconnection and thereby moving the first metatarsal relative to the firstcuneiform in a first plane; moving the second portion of the bonepositioning device relative to the first portion of the bone positioningdevice about the second rotating connection and thereby moving the firstmetatarsal relative to the first cuneiform in a second plane; removing aleading edge of the first metatarsal and removing a leading edge of thefirst cuneiform; sliding the second portion of the bone positioningdevice relative to the first portion of the bone positioning device toapply a compression force between the first metatarsal and the firstcuneiform; and fixing a position of the first metatarsal relative to thefirst cuneiform with a bone connector.
 20. The method of claim 19,wherein: the first plane is a plane defined by X- and Y-axes, and thesecond plane is a plane comprising a Z-axis.
 21. The method of claim 19,wherein the first portion of the bone positioning device comprises afirst aperture and the second portion of the bone positioning devicecomprises a second aperture, and further comprising: inserting a firstfixation pin into the first aperture of the first portion and into thefirst cuneiform; and inserting a second fixation pin into the secondaperture of the second portion and into the first metatarsal.
 22. Themethod of claim 19, wherein the bone positioning device comprises ascrew, and sliding the second portion of the bone positioning devicerelative to the first portion of the bone positioning device to applythe compression force comprises actuating the screw.
 23. The method ofclaim 19, wherein removing the leading edge of the first metatarsal andremoving the leading edge of the first cuneiform comprises cutting theleading edge of the first metatarsal with a cutting tool and cutting theleading edge of the first cuneiform with the cutting tool.
 24. Themethod of claim 23, further comprising aligning a bone cutting guidewith the joint, wherein cutting the leading edge of the first metatarsalwith the cutting tool comprises guiding the cutting tool with the bonecutting guide to cut the leading edge of the first metatarsal andcutting the leading edge of the first cuneiform with the cutting toolcomprises guiding the cutting tool with the bone cutting guide to cutthe leading edge of the first cuneiform.
 25. The method of claim 23,wherein cutting the leading edge of the first metatarsal with thecutting tool and cutting the leading edge of the first cuneiform withthe cutting tool comprises cutting the leading edge of the firstmetatarsal with the cutting tool and cutting the leading edge of thefirst cuneiform with the cutting tool after moving the first metatarsalrelative to the first cuneiform in the first plane and the second plane.26. The method of claim 19, wherein the bone connector is configured topromote fusion between the first metatarsal and the first cuneiform. 27.The method of claim 19, wherein the bone connector comprises one or moreof a plate, a screw, a pin, and a staple.
 28. The method of claim 19,wherein moving the first metatarsal relative to the first cuneiform inthe first plane and the second plane comprises correcting an alignmentbetween the first metatarsal and the first cuneiform to correct abunion.
 29. The method of claim 19, wherein: the bone positioning devicecomprises a link connecting the first portion to the second portion; thefirst rotating connection connects the second portion of the bonepositioning device to the link; and the second rotating connectionconnects the first portion of the bone positioning device to the link.30. The method of claim 19, wherein: the first rotating connectioncomprises a first ball received in a first socket; and the secondrotating connection comprises a second ball received in a second socket.